(1) The Commissioner may, in lieu of suspension or revocation
of a certificate of authority under section eighteen of this
article, levy an administrative penalty in an amount not less than
one hundred dollars nor more than five thousand dollars, if
reasonable notice in writing is given of the intent to levy the
penalty and the health maintenance organization has a reasonable
time within which to remedy the defect in its operations which gave
rise to the penalty citation. The Commissioner may augment this
penalty by an amount equal to the sum that he or she calculates to
be the damages suffered by enrollees or other members of the
public.

(2) Any person who violates any provision of this article
shall be guilty of a misdemeanor and, upon conviction thereof,
shall be fined not less than one thousand dollars nor more than ten
thousand dollars, or imprisoned in jail not more than one year, or
both fined and imprisoned.

(3)(a) If the Commissioner has cause to believe that any
violation of this article or rules promulgated pursuant to this
article has occurred or is threatened, prior to the levy of a
penalty or suspension or revocation of a certificate of authority,
the Commissioner shall give notice to the health maintenance
organization and to the representatives, or other persons who
appear to be involved in the suspected violation, to arrange a
conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the
facts relating to the suspected violation and, in the event it
appears that any violation has occurred or is threatened, to arrive
at an adequate and effective means of correcting or preventing the
violation.

(b) Proceedings under this subsection shall not be governed by
any formal procedural requirements and may be conducted in a manner
the Commissioner determines appropriate under the circumstances.
Enrollees shall be afforded notice by publication of proceedings
under this subsection and shall be afforded the opportunity to
intervene.

(4)(a) The Commissioner may issue an order directing a health
maintenance organization or a representative of a health
maintenance organization to cease and desist from engaging in any
act or practice in violation of the provisions of this article or
regulations promulgated pursuant to this article.

(b) Within ten days after service of the order of cease and
desist, the respondent may request a hearing on the question of
whether acts or practices in violation of this article have
occurred. The hearings shall be conducted pursuant to chapter
twenty-nine-a of this code and judicial review shall be available
as provided by chapter twenty-nine-a of this code.

(5) In the case of any violation of the provisions of this
article or rules promulgated pursuant to this article, if the
Commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued
pursuant to subsection (4) of this section, the Commissioner may
institute a proceeding to obtain injunctive relief, or seek other
appropriate relief, in the circuit court of the county of the
principal place of business of the health maintenance organization.

(6) Any enrollee of or resident of the service area of the
health maintenance organization may bring an action to enforce any
provision, standard or rule enforceable by the Commissioner. In
the case of any successful action to enforce this article, or
accompanying standards or rules the individual shall be awarded the
costs of the action together with a reasonable attorney's fee as
determined by the court.

Note: WV Code updated with legislation passed through the 2016 Regular Session
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